TreatmentUpdate 75. 9(1): 2-3; January, 1997
Sean Hosein

Background

Bacteria pneumonia (BP) is a complication that can occur in people with HIV/AIDS (PHAs). Some studies have found that PHAs taking the antibiotic Bactrim/Septra(R) to prevent PCP are also protected from BP. Doctors in Italy reviewed their hospital records to find out which of their HIV-infected patients taking Bactrim/Septra developed BP.

Study Details

Reviewing records from 1990 to 1995, the doctors found ?167 HIV-infected patients? who had BP. Nearly 80% were injection drug users; 35% were female and 65% male. Patients who had less than 200 CD4+ cells were at increased risk of BP compared to others who had more than 200 cells.

The doctors compared records from each of their patients with BP who had used some form of PCP prevention:

• Bactrim/Septra
• dapsone-pyrimethamine
• aerosol pentamidine

with records from two other PHAs who:

• had not developed BP
• were also taking antibiotics to prevent PCP
• had less than 200 CD4+ cells

Results

Comparing the two groups of patients, the doctors found that subjects receiving Bactrim/Septra were less likely to develop BP. However, not every patient using Bactrim/Septra was protected from BP. Patients who had recovered from an episode of PCP and then began taking Bactrim/Septra to prevent another episode of PCP, were just as likely to develop BP as patients who used dapsone-pyrimethamine or aerosol pentamidine.

Why?

The researchers think that once a person has an episode of PCP, their lungs may be damaged, making it easier for bacteria to infect. As well, certain "immune defences" that can contain BP weaken over time. Bactrim/Septra is very useful--providing some protection from PCP and the life-threatening brain infection toxo (toxoplasmosis). PHAs who have had an episode of PCP and who use Bactrim/Septra are still at risk of BP. Perhaps doctors may wish to provide more intensive monitoring for such patients and consider the use of additional antibiotics.

REFERENCE:

1. Tumbarello M, Tacconelli E, Cauda R and Ortona L. Secondary pneumocystis carinii pneumonia prophylaxis with trimethoprim-sulphamethoxazole does not prevent bacterial pneumonia in HIV-infected persons. AIDS 1996; 10(13): 1603-1604.

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